POS0725 CRANIAL, EXTRACRANIAL AND MIXED INVOLVEMENT IN GIANT CELL ARTERITIS: ANALYSIS OF THE CLINICAL DIFFERENCES
Authors: m. d. c. uyaguari morocho, e. fernández-fernández, i. monjo, e. de miguel
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> giant cell arteritis (gca) is a systemic vasculitis that affects large vessels, with a higher incidence in patients aged 70 years. It is known that GCA involves temporal arteries and the aorta and its branches either concomitantly or in isolation. Differentiating the characteristics in the expression of these disease subtypes will be relevant for the initial treatment, prognosis and the follow up. <h3>Objectives</h3> To analyze the different clinical and laboratory between the patterns of GCA involvement. <h3>Methods</h3> Retrospective study of new consecutive patients diagnosed with GCA for four years. 90.9% were diagnosed by Color Doppler ultrasound, measuring the superficial temporal arteries, common trunk, their frontal and parietal branches, and the extracranial arteries (axillary, subclavian, and carotid arteries). 9.1% were diagnosed by PET-CT or temporal artery biopsy. Ultrasound diagnosis was according to the OMERACT definitions of the halo sign and an intima-media cut off a thickness of ≥0.34 mm for the temporal arteries, ≥0.42 in the common superficial temporal artery and ≥ 1 mm for the axillary, subclavian, and carotid arteries. Clinical records were reviewed and their demographic, clinical and laboratory data were compared between patterns of ultrasound involvement. The EULAR recommendations of 2018 <sup>[1]</sup> were used to the remission and relapse. <h3>Results</h3> A total of 163 patients were included, 50.3% women, with a mean age of 79 years. Regarding the GCA subtypes, 78 patients had exclusive involvement of cranial arteries (CGCA), 36 patients had isolated involvement of extracranial giant cell arteritis (LVGCA) and 49 patients had mixed forms with both cranial and extracranial involvement (MGCA) Table 1. The analysis showed that patients with LVGCA present constitutional syndrome more frequently, less anterior Ischemic optic neuropathy (AION) (p&lt;0.001) and less ESR values (p&lt;0.01) than patients with CGCA. Extracranial artery involvement in any of the subtypes showed a significant association with polymyalgia rheumatica (PMR), although this was not exclusive to LVGCA. CGCA was associated with more AION-type ischemic manifestations than LVGCA. Remission maintained for at least 6 months together with corticosteroid-free remission is higher in LVGCA. No statistically significant differences in relapses, both major and minor. <h3>Conclusion</h3> Clinical features are different between the different GCA patterns. Patients with LVGCA have a greater constitutional syndrome and lower ESR than patients with CGCA. CGCA was associated with more NOIA-type ischemic manifestations than LVGCA. PMR is more frequent in cases with large vessel involvement. There is more maintained and corticosteroid-free remission in patients with LVGCA. <h3>Reference</h3> [1]Hellmich B., et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2020; 79:19–30 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Mariela del Carmen Uyaguari Morocho: None declared, Elisa Fernández-Fernández: None declared, Irene Monjo Speakers bureau: Roche, Novartis, UCB, Gedeon, Richter, Consultant of: Roche, Eugenio de Miguel Speakers bureau: AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grünenthal, Janssen, Sanofi, Paid instructor for: Janssen, Novartis, Roche, Consultant of: AbbVie, Novartis, Pfizer, Galapagos, Grant/research support from: AbbVie, Novartis, Pfizer.